Evaluation of right ventricular systolic function in patients with systemic lupus erythematosus by fully automated three-dimensional ultrasound right ventricular quantitative software
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目的 应用全自动三维超声右室定量软件(3D Auto RV)评估系统性红斑狼疮(SLE)患者右室收缩功能,分析其与红细胞分布宽度(RDW)的相关性.方法 选取我院风湿免疫科诊断为SLE的患者70例,根据超声心动图测得的肺动脉收缩压(PASP)将其分为PASP≤30 mmHg(1 mmHg=0.133 kPa)者34例(Ⅰ组),30 mmHg<PASP<50 mmHg者20例(Ⅱ组)、PASP≥50 mmHg者16例(Ⅲ组);另选同期健康志愿者25例为对照组.各组均行二维超声心动图检查获取左室射血分数(LVEF)、右室面积变化率(RVFAC)、三尖瓣环收缩期平面位移(TAPSE)、三尖瓣环收缩期峰值速度(S');3D Auto RV获取右室舒张末期容积指数(EDVi)、收缩末期容积指数(ESVi)、右室每搏量(RVSV)、右室射血分数(RVEF)、右室游离壁纵向应变(RVFWLS)、室间隔纵向应变(SLS);实验室检查获取RDW.比较各组上述检查结果的差异.采用Spearman相关分析法分析右室收缩功能与RDW的相关性;采用多元线性回归分析筛选SLE患者右室收缩功能受损的独立影响因子.结果 与对照组和Ⅰ、Ⅱ组比较,Ⅲ组RVFAC减低,EDVi、ESVi均增高,差异均有统计学意义(均P<0.05);与对照组和Ⅰ组比较,Ⅱ、Ⅲ组RVEF、RVFWLS均减低,差异均有统计学意义(均P<0.05);与Ⅰ组比较,Ⅱ、Ⅲ组SLS均减低,差异均有统计学意义(均P<0.05).Ⅰ～Ⅲ组RDW均高于对照组,差异均有统计学意义(均P<0.05).Spearman相关性分析显示,EDVi、ESVi与RDW均呈正相关(r=0.211、0.251,均P<0.05),RVEF、RVFWLS、SLS与RDW均呈负相关(r=-0.284、-0.247、-0.251,均P<0.05).多元线性回归分析显示,RDW、PASP均为SLE患者右室收缩功能受损的独立影响因子(β=-0.704、-0.190,均P<0.05).结论 3D Auto RV可准确评估SLE患者早期右室收缩功能,且其与RDW呈负相关;RDW和PASP均为SLE患者右室收缩功能受损的独立影响因子.
Objective To evaluate the right ventricular systolic function in patients with systemic lupus erythematosus(SLE)by fully automated three-dimensional ultrasound right ventricular quantitative software(3D Auto RV),and to analyze the correlation between right ventricular systolic function and red blood cell distribution width(RDW).Methods A total of 70 patients diagnosed with SLE in the department of rheumatology and immunology in our hospital were selected,according to the pulmonary artery systolic pressure(PASP)measured by echocardiography,they were divided into 34 patients with PASP≤30 mmHg(1 mmHg=0.133 kPa,group Ⅰ),20 patients with 30 mmHg<PASP<50 mmHg(group Ⅱ),16 patients with PASP≥50 mmHg(group Ⅲ),respectively.Another 25 healthy volunteers(control group)were selected during the same period.Left ventricular ejection fraction(LVEF),right ventricular fractional area change(RVFAC),tricuspid annular plane systolic excursion(TAPSE)and tricuspid annular systolic peak velocity(S')were obtained by two-dimensional echocardiography in each group.Right ventricular end-diastolic volume index(EDVi),right ventricular end-systolic volume index(ESVi),right ventricular stroke volume(RVSV),right ventricular ejection fraction(RVEF),right ventricular longitudinal strain of right ventricular free wall(RVFWLS)and longitudinal strain of interventricular septum(SLS)were obtained by 3D Auto RV.RDW was obtained by laboratory examination.The differences of the above examination results in each group were compared.Spearman correlation analysis was used to analyze the correlation between right ventricular systolic function and RDW.Multiple linear regression was used to analyze the independent influencing factors of impaired right ventricular systolic function in patients with SLE.Results Compared with the control group and groups Ⅰ and Ⅱ,RVFAC was decreased,EDVi and ESVi were increased in group Ⅲ,and the differences were statistically significant(all P<0.05).Compared with the control group and group Ⅰ,RVEF and RVFWLS in groups Ⅱ and Ⅲ were decreased,and the differences were statistically significant(all P<0.05).Compared with group Ⅰ,SLS in groups Ⅱ and Ⅲ were decreased,and the differences were statistically significant(both P<0.05).RDW in groups Ⅰ～Ⅲ was higher than that in the control group,and the differences were statistically significant(all P<0.05).Spearman correlation analysis showed that EDVi and ESVi were positively correlated with RDW(r=0.211,0.251,all P<0.05),and RVEF,FWLS and SLS were negatively correlated with RDW(r=-0.284,-0.247,-0.251,all P<0.05).Multiple linear regression analysis showed that RDW and PASP were independent influencing factors of impaired right ventricular systolic function in SLE patients(β=-0.704,-0.190,both P<0.05).Conclusion 3D Auto RV could accurately assess the right ventricular systolic function in patients with SLE,and right ventricular systolic function is negatively correlated with RDW.Both RDW and PASP are independent influencing factors of impaired right ventricular systolic function in SLE patients.
Three-dimensional ultrasound right ventricular quantitative software,fully automaticSystemic lupus erythematosusSystolic function,ventricle,rightRed blood cell distribution width
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